Selective patellar resurfacing with or without denervation as the ultimate answer: current concepts

Abstract

Management of the patella during primary total knee arthroplasty remains an unanswered question. Internationally, there is significant variation in the approach to resurfacing with some geographic regions resurfacing almost universally, and other regions rarely resurfacing. This difference in preference is a result of the different geographic locations, and is influenced by where the surgeons were trained, what was taught during their training, their patients' patellae profiles, financial condition and hospital policy where the surgeons practise. In this current concepts review, we investigate where we are now with patellar resurfacing during total knee arthroplasty from an international perspective, and the differences in outcomes between resurfaced and non-resurfaced patellae. In the end, the decision to resurface or not to resurface remains at the surgeon's discretion and is highly influenced by both medical and non-medical reasons. This review includes an alternative method to address anterior knee pain, which can be an additional management option apart from resurfacing or non-resurfacing for patients where patellar resurfacing is not a viable option, such as in very thin patellae. Moreover, we will also describe other variables that may play a role in causing persistent anterior knee pain, for instance soft tissue imbalance around the patella or improper positioning of the components. It may be important to address these factors to prevent undesirable postoperative outcomes.